Elevance Health bid on 11 national accounts in competing Blue Cross Blue Shield markets last year and won nine of them, the company said on its 2025 earnings call with investors, offering the first look at how a landmark antitrust settlement is reshaping competition within the Blues ecosystem.
“This is the first year that we’ve had the opportunity for employers in competing geographies against us who could actually quote with our organization if they wanted,” Morgan Kendrick, Elevance’s president of commercial and specialty health benefits, said Jan. 28.
The provision, known as the “second blue bid,” stems from a $2.67 billion settlement that resolved allegations dating back to 2012 that BCBS companies conspired to divide up markets and avoid competing with one another, thereby driving up costs for consumers. Among other changes, the settlement struck down a rule that required large employers to work with the BCBS insurer covering the geography where the employer is headquartered.
Now, for certain large national accounts, employers can solicit bids from any BCBS plan in the country, not just the one licensed in their service area. Elevance’s 9-for-11 record is the first concrete data point on how the settlement is reshaping competition among Blues plans, but industry observers say the effects could stretch beyond one selling season.
Ari Gottlieb, a consultant to insurers and owner of A2 Strategy, told Becker’s the provision will primarily benefit BCBS plans with the existing scale and technology to compete nationally.
“It’s really only going to be a handful of Blues that have scalable administrative platforms and the ability to really compete for this business,” Mr. Gottlieb said. He pointed to Elevance, HCSC and Highmark as likely competitors.
But the same dynamics that benefit large Blues could put smaller plans at risk, particularly those in states with a high concentration of national accounts.
“I think it puts at risk a handful of Blues and makes it more likely they look for a partner, particularly those that are exposed to a large account or two,” Mr. Gottlieb said.
He added that the second blue bid could accelerate a consolidation trend already underway across the BCBS system. In 2025 alone, Cambia Health Solutions, owner of four Regence Blues plans, announced affiliations with BCBS North Dakota and Arkansas BCBS, and Highmark announced an affiliation with BCBS Kansas City.
Elevance’s nine wins don’t necessarily mean nine losses for other BCBS plans though. Mr. Gottlieb noted that some of the business may have been taken from other insurers, and that some wins may have involved partnerships with local Blues plans rather than direct competition against them. Elevance operates Anthem BCBS plans in 14 states.
He also noted that the dynamic cuts both ways for Elevance. “This can be done to them as well,” he said.
The Blue Cross Blue Shield Association declined to comment on Elevance’s remarks.
